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Application of "Value Engineering" to Rationalize the Cost of Cataract Surgery in Eye Clinic at Tata Main Hospital

S.P. Jakhanwal, G.B. Singh

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Topics

Idea No 1: Work done on Pre and Post Op days can easily be performed at OPD and do not necessarily require hospitalization. At the same time hospitalization on Operation day would continue thus no abandonment of Pre and Post Op procedures and no compromise with Basic Function. This was most Cost-effective also (saving of approx Rs. 200/- per patient) and was easy to implement. Thus Idea No 1 scored highest = 106.

Idea No’s 2 and 3: Comparing these two ideas it is to be noted that both rated same for (against) Criteria A; while for (against) Criteria B and C the Idea No 2 was rated lower than C. It was also noted that for discharge making on a Sunday (Idea2), the hospital Office had to be opened which required management permission, while change of O.T. date (Idea 3) can be decided by the Hospital Superintendent, which was easier. (Score: Idea 2=78; and Idea 3 = 92).

Recommendation Phase:

Objective: To collect additional pertinent data and to thoroughly analyse the best alternative emerging from Evaluation Phase; and prepare Cost Estimates and modify proposals to ensure flexibility if implemented.

For Idea No 1: All members of team were unanimous and recommended for implementation. (Score: 106)

For Ideas No 2: The management was unwilling as it required opening the Hospital Office on a Sunday for which “overtime” had to be paid, making the idea “costly”; moreover, it was against current policy. The idea was therefore finally not included for recommendation (Idea scored lowest: Score 78) For Idea No. 3: Required only slight change in routine without involving any extra expenditure and was recommended for implementation. (Idea scored:92)The Team finally recommended for following changes:

  1. To reduce Pre and Post Op Stay (Idea No.1)
  2. Saturday O.T. to be changed to some other working day. (Idea No.3)

Presentation phase:

Objective: To put the Recommendation Alternatives in such convincing terms that the Decision makers willingly accept them.

Along with a written report, oral presentation was also made to convince the management.

The report was accepted by management and implementation followed.

Implementation phase:

Objective: To ensure that the approved proposal is rapidly and properly translated into action.

Post Implementation Schedule

  1. Cases for Operation in the morning half:

    • Admission: same day in the morning

    • Discharge: same day in the evening

    • Post Op: Advised to visit TMH Eye OPD next morning for exam and dressing

  2. Cases for Operation in the evening half:

    • Admission: after 12 noon on the day of operation

    • Discharge: next day morning after Post Op exam and dressing

  3. Saturday evening O.T. was changed to Wednesday evening

N.B: No Pre or Post Op essential medical procedures were omitted/abandoned in the newly recommended schedule. They were done at OPD.

Audit Phase Objective: To validate whether desired results have been attained, properly documented and reported.

Results:

1. Effects of Implementation of Recommendation No. 1 and 2 are summarized (in Table 4)

Table 4: Effects of Implementation of Recommendation No. 1 and 2:

Item Pre-implementation Per patient (Rs.) Post implementation per patient (Rs.) Saving per patient(Rs.) Total Cataract Op in Year (No.) Total Saving in year (Rs.)
Bed days 2.33 1.11 1.22 1100 1342
Bed Cost (Rs.) 400 200 200 1100 220000

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